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THER EX > lecture 3 continued: clinical uses of electrical sitmulation currents > Flashcards

lecture 3 continued: clinical uses of electrical sitmulation currents Flashcards

1
Q

what are the 4 levels that changes in the physiologic functioning as electricity moves thru the body’s conductive medium

A

✧ Cellular
✧ Tissue
✧ Segmental ✧ Systemic

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2
Q

what is the physiologic response to electrical current at a cellular level (5)

A

• Excitation of nerve cells
• Changes in cell membrane permeability
• Protein synthesis
• Stimulation of fibroblasts
and osteoblasts
• Modification of microcirculation

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3
Q

what is the physiologic response to electrical current at a tissue level (3)

A

• Skeletal muscle contraction
• Smooth muscle contraction
• Tissue regeneration

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4
Q

• Modification of joint mobility
• Muscle pumping action to change circulation and lymphatic activity
• Alteration of the microvascular system not associated with muscle pumping
• Increased movement of charged proteins into the lymphatic channels

these are physcilogic response to electrical currents at which level

A

segmental

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5
Q

• Analgesic effects as endogenous pain suppressors are released and act at different levels to control pain
• Analgesic effects from the stimulation of certain neurotransmitters to control neural activity in the presence of pain stimuli

these are physiological responses to the electrical current at which level

A

systemic

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6
Q

what are the 6 types of electrical stimulation currents

A

-electrical stimulation (NMES, FES)
- russian currents
-interferential currents (IFC)
- high volt pulsed current
-Transcutaneous Electrical
Nerve Stimulation (TENS)
- low volt current (DC)

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7
Q

which electrical current has symmetric biphasic currents

A

TENS

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8
Q

which electrical stimulation has twin peak pulsed waveforms

A

high volt pulsed current

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9
Q

which type of electrical stimulation has pulsatile biphasic waveform (2k-10k HZ)

A

russian currents

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10
Q

what type of electrical stimulation is a pulsed waveform and single or multiple channel electrical simulators programmed in a synergistic sequence

A

Electrical stimulation (NMES, FES)

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11
Q

Clinically, “TENS” refers to ES applied for ___ ___

A

pain reflief

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12
Q

what are the stages someone goes to as u crank up the electrical simulation

A

sub sensory
sensory
motor
noxious

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13
Q

what clinical stimulation level is someone at if there is no nerve activation and no sensory awareness

A

sub sensory

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14
Q

what clinical simulation level is someone at if they feel tingling , prickling , or pine and needles or there is cutaneous A - beta nerve fiber activation

A

sensory

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15
Q

what clinical simulation level is someone at if there is
- strong parasthesia
-mm contraction
-A alpha never fiber activation

A

motor

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16
Q

what clinical stimulation level is it if
- strong uncomfortable parasthesia
-strong mm contraction
-sharp or burning pain sensation
- A delta and C fiber activation

A

noxious

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17
Q

what type of fiber is recruited first for voluntary motor level stimulation

A

1

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18
Q

what type of fiber is recruited first for an electrically induced motor level stimulation

A

2

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19
Q

what is The location of skin above the muscle in which an electrical pulse applied transcutaneously evokes a muscle twitch with the least injected current.

A

motor points

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20
Q

motor points is where the threshold is ___ for a given electrical input

A

low

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21
Q

___ ____ stimulation gives the best individual muscle contraction

A

motor point

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22
Q

what kind of waveform is a high volt current

A

Twin-peak monophasic pulsed waveforms

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23
Q

what are the 2 main uses for high volt currents

A

reducing edema and wound healing

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24
Q

what current is preferred over high volt current for pain control

A

IFC and TENS

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25
Q

what currents is the best for MM contraction

A

russians and NMES

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26
Q

what is a monopolar high volt application

A

2 unequal sized electrodes

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27
Q

where is the active and dispersive electrode places for a monopolar high volt current

A

active is the smaller one over the treatment site and dispersive is the larger one placed somewhere away from treatment site

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28
Q

when during the phases of healing is negative polarity and positive polarity for high voltage most effective

A

negative is most effective during the inflammatory phase of healing and postivie is most effective during the proliferation phase of healing

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29
Q

____ of the electrode attracts charged ion and promote faster healing

A

Polarity

30
Q

does edema control what polarity for u use for high volt

A

negative

31
Q

what is the frequency and intensity and treatment time for high volt edema control

A

f: 120 pps
I: 30-50V or 10% less than that needed to produce a visible mm contraction
TT: 30 min session

32
Q

which electrical current Uses gate control theory, the descending control theory, and endogenous opiate pain control theory.

A

TENS (asymmetric biphasic current)

33
Q

pulse amplitude is the same as what

A

intensity

34
Q

pulse width is the same as what

A

duration

35
Q

pulse frequency is the same as what

A

rate

36
Q

conventional TENS is for ___ rate and ___ intensity (sensory level )

A

high and low

37
Q

what is conventional TENS best for

A

acute pain

38
Q

what theory does conventional TENS use and what does it stimulation

A

gate control theory - stimulates A-beta fibers

39
Q

the acupuncture like TENS would be used at ___ rate and ___ intensity (___ level_

A

low rate nd high intensity at the motor level

40
Q

what is acupuncture like TENS usually used for

A

chronic pain

41
Q

what theory does acupuncture TENS use and what does it release

A

Descending Pain control Theory – release of enkephalin

42
Q

what level of TENS is hyperstimulation analgesia

A

noxious level

43
Q

what theory dies the noxious level of TENS use

A

Endogenous opiate pain control theory

44
Q

which TENS units does high rate and high intensity for fast pain relief during prodcueure wound debridement with peripheral and central analgesia

A

brief intense

45
Q

___ ____ is the most common conventional TENS

A

Asymmetrical biphasic

46
Q

what is the following for conventional TENS

• Frequency:
• Duration:
• Intensity:
• Treatment time:

A

• Frequency: 80 - 125 pps
• Duration: 75 - 150 microseconds
• Intensity: Tolerable sensory stimulation
• Treatment time: until pain is no longer

47
Q

what theory is • Increased activity of A-beta afferents triggers the release of enkephalin from interneurons in Substantia Gelatinosa (SG), which inhibit synaptic transmission to 2nd order neurons (transmission (T) cells) and block pain message ascending to the brain

A

the gate control theory

48
Q

what is the frequency , duration , intensity , duty and treatment time for LOW frequency TENS ( Acupuncture like - motors level)

A

f: < 20 pps
D: 100-600 microseconds
I: high enough to elicit both a sensory and motor
Duty: 30-60s on , off time as needed
TT: 15-60 mins

49
Q

where is Low-Frequency TENS (Acupuncture-like, motor-level)applied over

A

motor point

50
Q

what is the Frequency, duration , intensity , duty and TT for Noxious level TENS

A

F: 1-5 pps
D: 100-1000 microseconds
I: high intensity to a noxious level (mm contraction is ok)
Duty: 30-45 secs , off time as needed
TT: until pain no longer there

51
Q

where is Noxious-Level TENS applied over

A

trigger or acupuncture points

52
Q

• Peripheral blockage and extra-segmental analgesia
• Stimulation of the small afferents (A-delta and C) can stimulate the release of endorphins, beta-endorphin and dynorphin
• Beta-endorphin is released by anterior pituitary gland and hypothalamus
• Prolonged electrical stimulation on acupuncture points triggers the release of beta-endorphin and dynorphin

that theory is this

A

Endogenous Opiate Pain Control Theory

53
Q

what is the following for **brief intense TENS **

  • Frequency:
  • Duration:
  • Intensity:
  • Treatment time:
A
  • Frequency: 100 pps
  • Duration: 100 - 600 microseconds
  • Intensity: Muscle fasciculation to sustained
    muscle contraction
  • Treatment time: ~ 15 minute
54
Q

what is the main thing brief intense TENS is used for

A

wound debridement

55
Q

• Serotonergic efferents: A descending system from thalamus stimulates the periaquedutal gray and the raphe nucleus to activate enkephalin interneurons
• Serotonin suppresses the release of substance P by A-delta and C fibers • Enkephalin is released to block signal transmission of 2nd order neurons
(lateral spinothalamic tract)
• Noradrenergic pathways: projects from pons to dorsal horn

what theory is this

A

Descending Pain Control Theory:
Peripheral and Central Analgesia

56
Q

what is the difference between NMES and TENS

-waveform
-pps
-duration
-channels
-output/ duty
- modulations
-timer

A

-NMES is sym or asym wave form and TENS is usually only 1
-fixed or few rate options (20-50pps) for NMES and for TENS rate options are 1-150pps
- NMES has a fixed pulse duration where TENS is variable pulse duration
- NMES is sim or alt channel activation and TENS is same to both channels
- NMES has duty cycle settings and TENS is a constant output
- NMES only has ramping modulations and TENS has rate&or duration &/or amplitude modulations
- NMES has a timer and TENS doesn’t

57
Q

what do you use russian currents for

A

mm strenghtening and mm re-education

58
Q

Should you substitute therapeutic exercise with Russian E-Stim?

A

no

59
Q

what is the burst mode for russian currents

A

50% on/off

60
Q

what are the advantages for russian currents

A

-high frequency currents reduce resistant to flow , making waveform comfortable enough to handle more
- as intensity increases more motor nerves are simulated increased the contraction
- as soon as a nerve repolarize it stimulated again , producing a current that will maximally summate mm contraction

61
Q

what is interfernetial currents used for (IFC)

A

pian control and mm spasm

62
Q

IFC prodocues ___ waves at ___ frequencies

A

sine
different

63
Q

which currents for u cross two bipolar configurations

A

IFC

64
Q

what is the Interferential Currents: Sweep mode

A

allows the frequencies of the current to be modulated , resulting in. a modulated beat frequency

65
Q

what do u want to avoid with Interferential Currents: Sweep mode

A

accommodation by beat frequencies

66
Q

which IFC mode can you Provide both high and low frequency stimulation within the
same treatment area

A

sweep

67
Q

what does the Interferential Currents: Scan mode allow

A

allow the amplitude of the input currents to the modulated

68
Q

if a patient has a poorly localized pain what does Interferential Currents: Scan mode do

A

moves forces around. while the treatment is taking place enlarging effective treatment area

69
Q

how many electrodes is pre mod

A

only 2 pads

70
Q

which current is there Two currents that are interfered within the device before delivering the current to the patient

A

Premodulated (Bipolar) Interferential Current

71
Q

what is the biphasic pulse rate and duration for NMES or FES for mm reeducation and strengthening

A

pulse rate - 35-55 pps
Duration: 200-600 us

THER EX (14 decks)

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